Individual
BRIAN D IVESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DSCPT
Contact information
Practice address
3259 CATLIN AVE, QUANTICO, VA 22134-5109
(703) 784-3205
Mailing address
3259 CATLIN AVE, QUANTICO, VA 22134-5109
(703) 784-3205
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501010161
MI
Other
Enumeration date
02/16/2006
Last updated
04/03/2024
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